Cervical Disc Disease and Cervical Spondylosis

Question 1

Cervical disc herniation occurs most commonly at?

Answer 1

C6/C7, less commonly at C5/C6

Question 2

Presentation of cervical disc prolapse?

Answer 2

• Pain in neck
• Arm/hand sensory disturbance
• Sensory disturbance > pain to localize root nerve cause

Question 3

Key exam features for cervical disc prolapse?

Answer 3

• Pt in lateral tilt which relaxes the roots on the side of the concavity, flexion lessens tension on prolapse
• muscle wasting
• weakness in specific muscle groups
• loss of sensation
• check LL for long track signs such as: increased tone, pyramidal pattern of weakness, hyperreflexia, upgoing babinski = indicates compression of spinal cord!

Question 4

Weakness of elbow extension and finger extension lesion?

Answer 4

C6/C7 prolapse with C7 nerve compression

Question 5

Weakness of shoulder abduction?

Answer 5

C5 root lesion

Question 6

Weakness of elbow extension?

Answer 6

C6 root lesion

Question 7

Weakness of long flexor muscles, triceps, finger extensors, and intrinsic muscles?

Answer 7

C8 root lesion

Question 8

Weakness at elbow extension, absent triceps jerk, numbness or tingling in middle or index finger?

Answer 8

C6/C7 (C7 nerve root)

Question 9

Depressed supinator reflex, numbness or tingling in the thumb or index finger, occasionally mild weakness of elbow flexion?

Answer 9

C5/C6 with C6 nerve root

Question 10

Weakness of long flexor muscles, triceps, finger extensions and intrinsic muscles, diminished sensation in ring and little finger and on medial border of hand and forearm, depressed triceps jerk?

Answer 10

C7/T1 with C8 nerve root

Question 11

Differential for cervical disc prolapse?

Answer 11

• spinal tumor
• thoracic outlet syndrome
• pancoast tumor infiltrating roots of brachial plexus
• peripheral nerve entrapment such as carpal tunnel, median nerve syndrome, cubital fossa, ulnar palsy

Question 12

Conservative of CD herniation?

Answer 12

• bed rest
• cervical collar
• nsaids
• maybe muscle relaxants

Question 13

Indications for further investigations/surgery?

Answer 13

• pain, continuing for more than 10 days without benefit from conservative therapy
• significant weakness that does not resolve
• evidence of central disc prolapse causing cord compression (urgent!)

Question 14

Surgical options for cervical disc prolapse?

Answer 14

• cervical foraminotomy with excision of the disc prolapse

- anterior cervical disectomy with subsequent fusion

Question 15

What is cervical spondylosis?

Answer 15

• • degenerative arthritic process involving cervical spine and affects disc and joints
• • found in 75% of people over 50

Question 16

Differential diagnosis for neck pain?

Answer 16

• • minor/major muscular and ligamentous strain after trauma

- - if major injury think fracture dislocation or acute disc herniation